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Lethal Pulmonary Complications Significantly Correlate With Individually Assessed Mean Lung Dose In Patients With Hematologic Malignancies Treated With Total Body Irradiation.
A. Della Volpe, A. Ferreri, C. Annaloro, P. Mangili, A. Rosso, R. Calandrino, E. Villa, G. Lambertenghi-Deliliers, C. Fiorino
Published 2002 · Medicine
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PURPOSE To assess the impact of lung dose on lethal pulmonary complications (LPCs) in a single-center group of patients with hematologic malignancies treated with total body irradiation (TBI) in the conditioning regimen for bone marrow transplantation (BMT). METHODS The mean lung dose of 101 TBI-conditioned patients was assessed by a thorough (1 SD around 2%) in vivo transit dosimetry technique. Fractionated TBI (10 Gy, 3.33 Gy/fraction, 1 fraction/d, 0.055 Gy/min) was delivered using a lateral-opposed beam technique with shielding of the lung by the arms. The median lung dose was 9.4 Gy (1 SD 0.8 Gy, range 7.8--11.4). The LPCs included idiopathic interstitial pneumonia (IIP) and non-idiopathic IP (non-IIP). RESULTS Nine LPCs were observed. LPCs were observed in 2 (3.8%) of 52 patients in the group with a lung dose < or = 9.4 Gy and in 7 (14.3%) of 49 patients in the >9.4 Gy group. The 6-month LPC risk was 3.8% and 19.2% (p = 0.05), respectively. A multivariate analysis adjusted by the following variables: type of malignancy (acute leukemia, chronic leukemia, lymphoma, myeloma), type of BMT (allogeneic, autologous), cytomegalovirus infection, graft vs. host disease, and previously administered drugs (bleomycin, cytarabine, cyclophosphamide, nitrosoureas), revealed a significant and independent association between lung dose and LPC risk (p = 0.02; relative risk = 6.7). Of the variables analyzed, BMT type (p = 0.04; relative risk = 6.6) had a risk predictive role. CONCLUSION The mean lung dose is an independent predictor of LPC risk in patients treated with the 3 x 3.33-Gy low-dose-rate TBI technique. Allogeneic BMT is associated with a higher risk of LPCs.
This paper references
Patient dose estimation in TBI using portal film transit dosimetry in combination with semiconductor detectors
C. Fiorino (1996)
Consequences of two different doses to the lungs during a single dose of total body irradiation: results of a randomized study on 85 patients.
T. Girinsky (1994)
The Balancing act
J. AnneMiller (1976)
Single dose versus fractionated total body irradiation before bone marrow transplantation: radiobiological and clinical considerations.
J. M. Cosset (1994)
Clinical and physical aspects of total body irradiation for bone marrow transplantation in Nijmegen.
J. Hoogenhout (1990)
A CT-aided PC-based physical treatment planning of TBI: a method for dose calculation.
B. Sánchez-Nieto (1997)
Total-body irradiation for bone marrow transplantation.
C. Lawton (1999)
The balancing act: pneumonitis vs. relapse in cytoreductive regimens containing total body irradiation.
B. Shank (1996)
One hundred patients with acute leukemia treated by chemotherapy, total body irradiation, and allogeneic marrow transplantation.
T. Ed (1977)
Variation in the lung inhomogeneity correction factor with beam energy. Clinical implications.
D. Shimm (1985)
A comparison of single-dose and fractionated total-body irradiation on the development of pneumonitis following bone marrow transplantation.
T. Morgan (1996)
Long-term follow-up of patients undergoing allogeneic bone marrow transplantation for acute myeloid leukemia in first complete remission after cyclophosphamide-total body irradiation and cyclosporine.
J. Mehta (1996)
Influence of the fractionation of total body irradiation on complications and relapse rate for chronic myelogenous leukemia. The Groupe d'Etude des greffes de moelle osseuse (GEGMO).
G. Socié (1991)
In-vivo dosimetry by diode semiconductors in combination with portal films during TBI: reporting a 5-year clinical experience.
P. Mangili (1999)
Interstitial pneumonitis following total body irradiation for bone marrow transplantation using two different dose rates.
T. Kim (1985)
Total body irradiation for bone marrow transplantation: the Memorial Sloan-Kettering Cancer Center experience.
B. Shank (1990)
Interstitial pneumonitis following bone marrow transplantation after low dose rate total body irradiation.
A. Barrett (1983)
Interstitial pneumonitis after bone marrow transplantation. Assessment of risk factors.
R. Weiner (1986)
Total body irradiation in acute myeloid leukemia and chronic myelogenous leukemia: influence of dose and dose-rate on leukemia relapse.
D. Scarpati (1989)
Toxicity and dosimetry of fractionated total body irradiation prior to allogeneic bone marrow transplantation using a straightforward radiotherapy technique.
G. Gerrard (1998)
In vivo dosimetry during external photon beam radiotherapy.
M. Essers (1999)
Pulmonary complications occurring after allogeneic bone marrow transplantation. A study of 130 consecutive transplanted patients
C. Cordonnier (1986)
Fractionated versus low dose-rate total body irradiation. Radiobiological considerations in the selection of regimes.
J. O'Donoghue (1986)
Total body irradiation with or without lung shielding for allogeneic bone marrow transplantation.
B. Labar (1992)
Lethal pulmonary toxicity after autologous bone marrow transplantation/peripheral blood stem cell transplantation for hematological malignancies.
F. Lohr (1998)
Interstitial pneumonitis following autologous bone-marrow transplantation conditioned with cyclophosphamide and total-body irradiation.
M. Ozsahin (1996)
Fractionated total body irradiation in allogeneic bone marrow transplantation in leukemia patients: analysis of prognostic factors and results in 136 patients.
V. Donato (1998)
The physical aspects of total and half body photon irradiation : a report of Task Group 29, Radiation Therapy Committee, American Association of Physicitst in Medicine
J. V. Dyk (1986)
Physical aspects of total-body irradiation at the Middlesex Hospital (UCL group of hospitals), London 1988-1993: II. In vivo planning and dosimetry.
B. Planskoy (1996)
[Pulmonary complications occurring after allogeneic bone marrow transplantation].
Y. Fan (1998)
Marrow transplantation for acute nonlymphoblastic leukemic in first remission using fractionated or single-dose irradiation.
E. Thomas (1982)
Exit dose measurements by portal film dosimetry
C. Fiorino (1993)
Idiopathic interstitial pneumonia following bone marrow transplantation: the relationship with total body irradiation.
T. Keane (1981)
Dosimetry for total body irradiation.
E. Briot (1990)
Midplane dose determination during total body irradiation using in vivo dosimetry.
M. Ribas (1998)
Physical aspects of total-body irradiation at the Middlesex Hospital (UCL group of hospitals), London 1988-1993: I. Phantom measurements and planning methods.
B. Planskoy (1996)
Interstitial pneumonitis after total body irradiation: effect of partial lung shielding
Z. Weshler (1990)
Are port films reliable for in vivo exit dose measurements?
J. van Dam (1992)
Interstitial pneumonitis in acute leukemia patients submitted to T-depleted matched and mismatched bone marrow transplantation.
C. Aristei (1998)
A simple and robust method for in vivo midline dose map estimations using diodes and portal detectors.
S. Broggi (2001)
Methotrexate and cyclosporine compared with cyclosporine alone for prophylaxis of acute graft versus host disease after marrow transplantation for leukemia.
R. Storb (1986)
This paper is referenced by
Effect of dose fractionation on pulmonary complications during total body irradiation.
H. Izawa (2011)
Chapter 46 – Uncommon Thoracic Tumors
J. Zeng (2016)
transplantation idiopathic pneumonia syndrome after allogeneic bone marrow A critical role for CCR 2 / MCP-1 interactions in the development
W. Kuziel (2003)
Increased intensity lymphodepletion and adoptive immunotherapy—how far can we go?
P. Muranski (2006)
Estimation of radiation-induced organ-specific secondary solid tumor occurrence rates with total body irradiation and total marrow irradiation treatments.
C. Han (2020)
Chapter 18 – Total Body Irradiation
C. Barker (2016)
Clinical implementation of low-dose total body irradiation using topotherapy technique
Sara Broggi (2019)
Standardized flattening filter free volumetric modulated arc therapy plans based on anteroposterior width for total body irradiation
R. Frederick (2020)
Late effects of chronic graft-versus-host disease.
P. Carpenter (2008)
Targeted total marrow irradiation using three-dimensional image-guided tomographic intensity-modulated radiation therapy: an alternative to standard total body irradiation.
J. Wong (2006)
Influence of oral beclomethasone dipropionate on early non-infectious pulmonary outcomes after allogeneic hematopoietic cell transplantation: results from two randomized trials
J. Chien (2010)
pneumonia syndrome after allogeneic bone marrow transplantation A critical role for CCR2/MCP-1 interactions in the development of idiopathic
G. Yanik (2013)
CT‐based analysis of dose homogeneity in total body irradiation using lateral beam
S. Hui (2004)
Dose-dependent pulmonary toxicity after postoperative intensity-modulated radiotherapy for malignant pleural mesothelioma.
D. Rice (2007)
An official American Thoracic Society research statement: noninfectious lung injury after hematopoietic stem cell transplantation: idiopathic pneumonia syndrome.
A. Panoskaltsis-Mortari (2011)
Near-lethal respiratory failure after recombinant human thyroid-stimulating hormone use in a patient with metastatic thyroid carcinoma.
T. Goffman (2003)
A critical role for CCR 2 / MCP-1 interactions in the development of idiopathic pneumonia syndrome after allogeneic bone marrow transplantation
G. Hildebrandt (2004)
Risks and outcomes of idiopathic pneumonia syndrome after nonmyeloablative and conventional conditioning regimens for allogeneic hematopoietic stem cell transplantation.
T. Fukuda (2003)
Lung Injury Following Hematopoietic Cell Transplantation
K. Cooke (2009)
Verification of dose distribution for volumetric modulated arc therapy total marrow irradiation in a humanlike phantom.
M. Surucu (2012)
cell transplantation development of idiopathic pneumonia syndrome after allogeneic stem Donor T-cell production of RANTES significantly contributes to the
Chen Liu (2009)
Attenuator design for organs at risk in total body irradiation using a translation technique.
M. Lavallée (2008)
Donor-derived TNF-alpha regulates pulmonary chemokine expression and the development of idiopathic pneumonia syndrome after allogeneic bone marrow transplantation.
G. Hildebrandt (2004)
Total marrow irradiation with RapidArc volumetric arc therapy.
B. Aydogan (2011)
The lung as a target organ of graft-versus-host disease.
G. Yanik (2006)
Pathophysiology of Lung Injury After Hematopoietic Stem Cell Transplantation
K. Cooke (2004)
Idiopathic pneumonia syndrome following hematopoietic stem cell transplantation.
Orly R. Klein (2014)
A critical role for CCR2/MCP-1 interactions in the development of idiopathic pneumonia syndrome after allogeneic bone marrow transplantation.
G. Hildebrandt (2004)
15 – Total Body Irradiation
C. Barker (2010)
Total Marrow Irradiation: A Comprehensive Review
rey Y. C. Wong (2020)
Successful Unrelated Cord Blood Transplantation Using a Reduced-Intensity Conditioning Regimen in a 6-Month-Old Infant with Congenital Neutropenia Complicated by Severe Pneumonia
Y. Nakazawa (2004)
Acute lung injury after allogeneic stem cell transplantation: is the lung a target of acute graft-versus-host disease?
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